Healthcare Provider Details

I. General information

NPI: 1922274455
Provider Name (Legal Business Name): LENA KAKEHI M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 SW 141ST AVE #204
BEAVERTON OR
97005-2382
US

IV. Provider business mailing address

12388 SW 72ND AVE APT. 334
TIGARD OR
97223-8690
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-3260
  • Fax:
Mailing address:
  • Phone: 503-372-9743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: